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A new study in JAMA Network Open reveals a troubling mismatch: bladder cancer clinical trials are concentrated in areas with higher diagnosis rates, not where deaths are highest. Over 77% of US counties had zero trial sites between 2019 and 2025, and the most socially vulnerable communities were the least served. Researchers say expanding trials to high-mortality, high-vulnerability areas could help close the equity gap.
A new cross-sectional study published in JAMA Network Open exposes a stark geographic mismatch in bladder cancer clinical trial access across the US. Analyzing data from ClinicalTrials.gov covering June 2019 to June 2025, researchers found that 436 bladder cancer trials were active across just 713 counties — leaving 77.3% of the country's 3,145 counties with no trial sites at all.
The disconnect goes beyond geography. While counties with higher bladder cancer incidence were slightly more likely to host trials, counties with higher mortality rates were actually less likely to have them. Since mortality better reflects true disease burden than incidence (which can be skewed by screening practices), this means the communities with the greatest need are being left out. Socially vulnerable counties fared worst — trial rates were 2.5x higher in the least vulnerable counties compared to the most vulnerable.
By the Numbers:
Why it matters: Clinical trials are often patients' best shot at cutting-edge therapies. When trials cluster in more affluent, lower-mortality areas, the communities bearing the greatest disease burden get left behind — deepening health inequities in cancer care.
